Life-years lost associated with mental illness: a cohort study of beneficiaries of a South African medical insurance scheme.

Autor:	Ruffieux Y; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Wettstein A; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Maartens G; Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa., Folb N; Medscheme, Cape Town, South Africa., Vieira CM; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Graduate School of Health Sciences, University of Bern, Bern, Switzerland., Didden C; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute of Sociology, Ludwig-Maximilians-University, Munich, Germany., Tlali M; Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa., Williams C; Medscheme, Cape Town, South Africa., Cornell M; Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa., Schomaker M; Department of Statistics, Ludwig-Maximilans-Universität München, Germany., Johnson LF; Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa., Joska JA; HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.; Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa., Egger M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK., Haas AD; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2023 Feb 02. Date of Electronic Publication: 2023 Feb 02.
DOI:	10.1101/2023.01.19.23284778
Abstrakt:	Importance: People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. Objective: To quantify excess mortality due to natural and unnatural causes associated with mental illness. Design Setting and Participants: Cohort study using reimbursement claims and vital registration of beneficiaries of a South African medical insurance scheme, aged 15-84 years and covered by medical insurance at any point between January 1, 2011, and June 30, 2020. Exposures: ICD-10 diagnoses of mental disorders including organic, substance use, psychotic, mood, anxiety, eating, personality, and developmental disorders. Outcomes: Mortality from natural, unnatural, unknown and all causes, as measured by the life-years lost (LYL) metric. Results: We followed 1 070 183 beneficiaries (51.7% female, median age 36.1 years for a median duration of 3.0 years, of whom 282 926 (26.4%) received mental health diagnoses and 27 640 (2.6%) died. Life expectancy of people with mental health diagnoses was 3.83 years (95% CI 3.58-4.10) shorter for men and 2.19 years (1.97-2.41) shorter for women. Excess mortality varied by sex and diagnosis, ranging from 11.50 LYL (95% CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (3.42 among men and 1.94 among women). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder. Conclusions and Relevance: The burden of premature mortality among persons with mental disorders in South Africa is high. Our findings support implementing interventions for prevention, early detection, and treatment of physical comorbidities among people with mental disorders. Suicide prevention and substance use treatment programmes are needed to reduce excess mortality from unnatural causes, especially among men. Key Points: Question: How much shorter is the life expectancy of people with mental illness compared to the general population and how many life years are lost due to natural and unnatural causes of death? Findings: The life expectancy of people with mental health diagnoses was 3.83 years shorter for men and 2.19 years shorter for women. Most excess life years lost were attributable to natural causes (3.42 among men and 1.94 among women). However, bipolar and substance use disorders were associated with considerable premature mortality from unnatural causes. Meaning: Our findings support the implementation of interventions for improving the physical health of people with mental illness and targeted suicide prevention and substance use treatment programmes.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu